RN VATI COMPREHENSIVE ASSMT 2025|2026 REAL EXAM 180
QUESTIONS AND 100% CORRECT ANSWERS
1. A nurse is admitting a client who has posttraumatic stress disorder (PTSD). Which finding should the
nurse expect?
A. Talks continuously about the event
B. Preoccupied with having a serious illness
C. Has difficulty concentrating on a task
D. Experiences frequent grandiose thoughts
Answer: C
Rationale: PTSD often causes hyperarousal and difficulty concentrating due to intrusive thoughts and
anxiety.
2. A nurse is administering a scheduled medication to a client who reports that the medication looks
different from what they take at home. Which response should the nurse make?
A. “Did the doctor discuss with you that there was a change in this medication?”
B. “Do you know why this medication is being prescribed for you?”
C. “I will call the pharmacist now to check on this medication.”
D. “I recommend that you take this medication as prescribed.”
Answer: C
Rationale: Always verify any discrepancy before administration to ensure client safety and prevent
medication errors.
3. A nurse is assessing a client in skeletal traction for a fractured tibia. Which finding indicates altered
tissue perfusion?
A. Purulent drainage at the pin site
B. Faint pedal pulse of the affected leg
C. Pain with movement of the great toe
D. Warm skin temperature distal to the pin site
Answer: B
Rationale: A faint or absent pulse indicates impaired circulation and requires immediate intervention.
4. A nurse observes an unlicensed assistive personnel (UAP) improperly using a mechanical lift. What
action should the nurse take first?
A. Stop the UAP and provide immediate instruction.
B. Document the incident and report to the manager.
C. Allow completion, then discuss privately.
D. File a safety variance report.
,Answer: A
Rationale: Client safety is priority; stop unsafe practice immediately to prevent injury.
5. A nurse is reinforcing teaching about fire safety using the RACE acronym. Which action should the
nurse perform first if a fire occurs?
A. Activate the alarm
B. Contain the fire
C. Rescue clients in danger
D. Extinguish the fire
Answer: C
Rationale: The first step is to rescue anyone in immediate danger before activating the alarm or
containing the fire.
6. A nurse is caring for a client who has a new prescription for a condom catheter. Which action should
the nurse take?
A. Ensure the adhesive tape is tight to prevent leakage.
B. Leave 2.5–5 cm (1–2 in) space at the tip of the penis.
C. Shave the pubic hair before application.
D. Apply powder to improve adherence.
Answer: B
Rationale: Leave space to prevent irritation and allow urine flow without back pressure.
7. A nurse is caring for a client who is postoperative and reports pain. After administering an opioid
analgesic, which action should the nurse take next?
A. Evaluate pain relief and respiratory status.
B. Document administration in the MAR.
C. Notify the provider of pain relief.
D. Offer the client a back massage.
Answer: A
Rationale: Assessing effectiveness and monitoring for respiratory depression ensures safety and proper
evaluation.
8. A nurse is caring for a client who has Clostridioides difficile infection. Which precautions should the
nurse implement?
A. Airborne precautions
B. Droplet precautions
C. Contact precautions with soap and water handwashing
D. Protective environment precautions
Answer: C
, Rationale: C. diff requires contact precautions; alcohol-based sanitizers are ineffective—use soap and
water.
9. A nurse is reinforcing teaching about crutch walking with a client who is non–weight bearing on one
leg. Which statement indicates understanding?
A. “I should move my crutches and injured leg together.”
B. “I’ll place my weight on the crutches and move my good leg forward.”
C. “I’ll keep both feet on the floor when standing.”
D. “I’ll lean on my underarms for support.”
Answer: B
Rationale: Proper three-point gait involves moving crutches with the affected leg, bearing weight on
hands, and advancing the good leg.
10. A nurse is caring for a client who is receiving enteral feeding via nasogastric tube. Which action
should the nurse take before each feeding?
A. Flush the tube with 60 mL of water.
B. Verify residual volume and pH of gastric contents.
C. Advance the tube by 5 cm to ensure placement.
D. Aspirate only if the client shows discomfort.
Answer: B
Rationale: Checking placement and residual prevents aspiration and ensures appropriate feeding
tolerance.
11. A nurse is caring for a client who has a chest tube. The water seal chamber continuously bubbles.
What should the nurse do?
A. Tighten all connections and assess for air leaks.
B. Add sterile water to maintain the water level.
C. Notify the provider immediately.
D. Clamp the chest tube.
Answer: A
Rationale: Continuous bubbling indicates an air leak; inspect system integrity first.
12. A nurse is preparing to administer packed RBCs to a client. Which action should the nurse take first?
A. Verify client identity and blood product with another nurse.
B. Obtain baseline vital signs.
C. Start the infusion slowly for the first 15 minutes.
D. Check for informed consent.
Answer: D
Rationale: Consent must be verified before beginning any blood transfusion process.
QUESTIONS AND 100% CORRECT ANSWERS
1. A nurse is admitting a client who has posttraumatic stress disorder (PTSD). Which finding should the
nurse expect?
A. Talks continuously about the event
B. Preoccupied with having a serious illness
C. Has difficulty concentrating on a task
D. Experiences frequent grandiose thoughts
Answer: C
Rationale: PTSD often causes hyperarousal and difficulty concentrating due to intrusive thoughts and
anxiety.
2. A nurse is administering a scheduled medication to a client who reports that the medication looks
different from what they take at home. Which response should the nurse make?
A. “Did the doctor discuss with you that there was a change in this medication?”
B. “Do you know why this medication is being prescribed for you?”
C. “I will call the pharmacist now to check on this medication.”
D. “I recommend that you take this medication as prescribed.”
Answer: C
Rationale: Always verify any discrepancy before administration to ensure client safety and prevent
medication errors.
3. A nurse is assessing a client in skeletal traction for a fractured tibia. Which finding indicates altered
tissue perfusion?
A. Purulent drainage at the pin site
B. Faint pedal pulse of the affected leg
C. Pain with movement of the great toe
D. Warm skin temperature distal to the pin site
Answer: B
Rationale: A faint or absent pulse indicates impaired circulation and requires immediate intervention.
4. A nurse observes an unlicensed assistive personnel (UAP) improperly using a mechanical lift. What
action should the nurse take first?
A. Stop the UAP and provide immediate instruction.
B. Document the incident and report to the manager.
C. Allow completion, then discuss privately.
D. File a safety variance report.
,Answer: A
Rationale: Client safety is priority; stop unsafe practice immediately to prevent injury.
5. A nurse is reinforcing teaching about fire safety using the RACE acronym. Which action should the
nurse perform first if a fire occurs?
A. Activate the alarm
B. Contain the fire
C. Rescue clients in danger
D. Extinguish the fire
Answer: C
Rationale: The first step is to rescue anyone in immediate danger before activating the alarm or
containing the fire.
6. A nurse is caring for a client who has a new prescription for a condom catheter. Which action should
the nurse take?
A. Ensure the adhesive tape is tight to prevent leakage.
B. Leave 2.5–5 cm (1–2 in) space at the tip of the penis.
C. Shave the pubic hair before application.
D. Apply powder to improve adherence.
Answer: B
Rationale: Leave space to prevent irritation and allow urine flow without back pressure.
7. A nurse is caring for a client who is postoperative and reports pain. After administering an opioid
analgesic, which action should the nurse take next?
A. Evaluate pain relief and respiratory status.
B. Document administration in the MAR.
C. Notify the provider of pain relief.
D. Offer the client a back massage.
Answer: A
Rationale: Assessing effectiveness and monitoring for respiratory depression ensures safety and proper
evaluation.
8. A nurse is caring for a client who has Clostridioides difficile infection. Which precautions should the
nurse implement?
A. Airborne precautions
B. Droplet precautions
C. Contact precautions with soap and water handwashing
D. Protective environment precautions
Answer: C
, Rationale: C. diff requires contact precautions; alcohol-based sanitizers are ineffective—use soap and
water.
9. A nurse is reinforcing teaching about crutch walking with a client who is non–weight bearing on one
leg. Which statement indicates understanding?
A. “I should move my crutches and injured leg together.”
B. “I’ll place my weight on the crutches and move my good leg forward.”
C. “I’ll keep both feet on the floor when standing.”
D. “I’ll lean on my underarms for support.”
Answer: B
Rationale: Proper three-point gait involves moving crutches with the affected leg, bearing weight on
hands, and advancing the good leg.
10. A nurse is caring for a client who is receiving enteral feeding via nasogastric tube. Which action
should the nurse take before each feeding?
A. Flush the tube with 60 mL of water.
B. Verify residual volume and pH of gastric contents.
C. Advance the tube by 5 cm to ensure placement.
D. Aspirate only if the client shows discomfort.
Answer: B
Rationale: Checking placement and residual prevents aspiration and ensures appropriate feeding
tolerance.
11. A nurse is caring for a client who has a chest tube. The water seal chamber continuously bubbles.
What should the nurse do?
A. Tighten all connections and assess for air leaks.
B. Add sterile water to maintain the water level.
C. Notify the provider immediately.
D. Clamp the chest tube.
Answer: A
Rationale: Continuous bubbling indicates an air leak; inspect system integrity first.
12. A nurse is preparing to administer packed RBCs to a client. Which action should the nurse take first?
A. Verify client identity and blood product with another nurse.
B. Obtain baseline vital signs.
C. Start the infusion slowly for the first 15 minutes.
D. Check for informed consent.
Answer: D
Rationale: Consent must be verified before beginning any blood transfusion process.
